What drinking feels like when you’re alcoholic

A year in to sobriety, albeit with several one-time relapses, I am still in the period of what’s called Post-Acute Withdrawal Syndrome.  The body can still have physiological cravings for alcohol even after this long, and mine does.  When these cravings pop up, tremors in my hands still appear and I feel an overwhelming sense of pressure, accompanied by the insidious certainty that a few drinks would make it all go away for a couple of hours.

It’s a subject I’m reluctant to talk about, because it makes the people around me fearful, which scares me.  Generally, it seems that despite all the platitudes about asking for support (about which I’ve written before) the recovering alcoholic, especially past the acute phase, is pretty much expected to go it alone and pretend that everything is fine.  The guilt of even having cravings, let alone relapsing, is enormous: a sickening, drowning sensation that increases the drive to drink; a sense of intimate personal failure.  Encouragement is hard to come by; judgment is not.  Understanding of and sympathy for the addict’s experience is rare.

I’m hoping that if I am able to describe what goes through my head on the sporadic occasion that I do relapse, I can reduce some of this stigma and help others to speak openly about their experiences.  I can only speak for myself, although my understanding is informed by, in rehab, hearing many stories from other addicts that tend to agree with my own conclusions.

Using a substance of choice is incomparably different for an addict than for a non-addict.  Through force of habit, psychologically and physiologically, a huge set of feelings and circumstances are intricately tied up with cravings and bad choices.  Certain stores are triggers.  Certain foods are triggers.  Some people are triggers.  So are some subjective experiences: fear, uncertainty, loneliness, despair.  Automatic thoughts are entwined in the addicts brain that obsess over alcohol, or another substance: terrible sirens who proffer sanctuary from a stormy inner and outer world.

Because of these entangled threads of craving, the act of relapse is a powerful one.  There is a moment when the sirens succeed, when a decision is made to drink, with the full but rationalized knowledge that the single end goal is to get so drunk that nothing matters.  It’s a precipice.  To find a way to turn back once you leap is rare.

There is the moment when you purchase the alcohol.  It’s like you can almost feel it in your veins already.  Your mouth waters, your stomach grumbles, you already wrinkle your face at the anticipated taste of cheap straight liquor pouring over your tongue (because that’s the quickest, least expensive way to get fucked up)– equal parts revolting and relieving.  All you can think about is getting somewhere where you can open the bottle and chug.

And then there’s that moment, the most important of all.  The liquor hits your lips, your tongue, your throat, your stomach.  It burns.  It feels like a necessary scourge, eating away what feels like necrotic tissue in the chest, cauterizing all the wounds.  It feels like pure power.  It’s done; no one can stop you.  It’s a bad choice, you still feel overwhelming guilt, but it’s your choice, it’s done, and even before it kicks in it is exhilarating beyond description.  Every craving you’ve had leading up to the act is justified by that moment.  It’s like taking off a mask.  It’s like coming home.  It’s like throwing in the towel.

It starts to work, just a few minutes after the first sip if your stomach is empty.  You feel it in your legs first.  The hot feeling from your stomach grows downward and starts to dissolve you.  Well-being drowns you, insistent, surrounding and withering the black thoughts that still lie beneath.  Every bad effect drugs have ever had on you is voided.  Nothing matters.  All you want is more, one more, one more, until you can’t anymore, until you’re passed out or puking or both.

The deep-seated shame increases exponentially, leaving you feeling like a little kid who pooped on the floor not once but a hundred times.  And what’s the solution to shame and self-loathing?  Another drink, of course.  More oblivion, please.

You can’t avoid knowing that you will crash and burn when the miracle drug wears off.  If you drink multiple days in a row, you will go through acute withdrawal again, which gets worse and more dangerous every time.  The pain will return, and so will the guilt.  After you pass out, you eventually wake up, in horror at the sober world and your sober self.

And sometimes you just want someone to forgive you, to tell you it will be okay.  But no one wants to hear your sin.  No one wants you to be less than they expect you to be.

Through a lens clearly

I have a list of therapies that haven’t worked for me.

This is not out of spite or stubbornness.  It’s because I’m starting to see a new therapist soon, and it’s important to me that they know what I’ve already tried and have not found helpful.  I don’t want them to rehash former attempts; I want them to offer me something new.

As a result, I’ve written a lot recently about therapeutic experiences I’ve had that missed the mark.  This is not meant to discount the experience of people who find a type of therapy helpful.  My assertion is always that patients are very diverse, and therapists need to be more cognizant of those differences to ensure they aren’t following a one size fits all policy.

There is a frequent misconception that if a specific therapy is not helpful to a person, it’s a consequence of the patient not understanding, not practicing what they learned, or not trying hard enough.  In some cases one or more of these may be true.  However, it’s also true that everyone has certain methods and styles that work for them, as illustrated by the fact that some therapies for the same symptom seem to be polar opposites in approach.

One example is the advice I’ve received about coping with obsessive thoughts.  One therapist and the books he gave me advocated acknowledging the thoughts and labeling them as obsessive and unhelpful, then seeking distraction through enjoyable activities.  The next therapist felt strongly that I should not label my thoughts, but should “sit with them” and accept them, and practice mindfulness and distress tolerance.

In my case, the former style has been far and away more successful in alleviating my discomfort and increasing my functionality, even though it doesn’t always work.  (Does anything?)  So I’ve adopted it into a set of coping skills that also includes healthy habits like yoga, studying astronomy, and writing, as well as not-so-healthy ones like smoking tobacco, comfort eating, and, formerly, drinking.  However, I’ve taken some flack from certain professionals who think that I am not doing a good enough job and am simply lazy for taking a road that includes playing video games and watching nerdy TV shows I’ve seen a million times (hello, TNG!) instead of meditation.  One therapy is judged more praiseworthy than another, not because it’s working but essentially because of its cultural cachet.

This perception of people as failing by rejecting a therapy results in a certain amount of shame and reluctance to speak up.  I’ve witnessed this in rehab, where one patient was going through the one-month program for the eleventh time, and a large percentage had been there at least once before.  How is it expected that following the exact same process, with all the same information and advice, will help someone who has already “failed” ten times?  At what point should we recognize that something simply isn’t working?

Twelve-step programs are another great example.  The first question most health care workers ask when you describe yourself as an alcoholic is “do you attend Alcoholics Anonymous?”  When the answer is no, there is frowning involved.  Twelve-stepping is the only therapy many therapists seem to accept for addiction, despite its flaws.

AA touts the idea that its approach is nearly always successful, and that if it doesn’t work for someone, it’s because they are constitutionally, pathologically incapable of honesty and responsibility.  In my opinion, this is a way of saying that if a person doesn’t achieve sobriety through their method, they are a lost cause because they are simply too flawed.  There is an assumption that if you don’t do AA, you don’t really want to sober up, and won’t ever succeed.

But in reality, the program is successful in only 5 to 10% of cases, akin to the success rate of any other specific type of therapy in addiction cases.  Even assuming that half the cases in which people don’t get sober through twelve-stepping are caused by internal or external factors in the patient’s life (which I consider a fairly generous concession) upwards of 45% of cases can best be explained by the simple need to find a different therapy.

Even in cases where the widespread effectiveness of a specific therapy is scientifically demonstrated, this does not constitute a reason to insist on one therapy and dismiss others in any given patient.  Naturally, if the success rate is 90% (based on a certain definition of success and method of research) then one in ten people is still not achieving optimal results.  Isn’t that a large enough percentage that it deserves a change in attitude; an increased willingness to shift gears and listen to patients about what works for them?

My favorite therapist I’ve had, who first raised the possibility of autism with me, used to say that it’s all about through what lens you approach a problem.  Two people’s respective symptoms may receive the same diagnosis, yet stem from totally different causes and require a different lens in order to clearly understand and effectively threat them.  He suggested that my autistic tendencies are likely so deeply rooted, being, of course, not a mental illness but a neurological difference, that failure to acknowledge them– particularly in treatment of my social anxiety– had probably caused a lot of my therapy to involve barking up the wrong tree.

After spending several months addressing autism issues and going over my symptoms to see if they were in accord with the diagnosis, the sheer relief I felt was like coming up for air.  I had a lexicon, for the first time, to describe my experience of life, and validation of the fact that I felt different but that the difference might not actually be a flaw.  I think the day I was tentatively diagnosed with autism began a whole new stage of my life and certainly of my mental health.

Not every experience I’ve had with therapy– as I’ve written about before– has been so positive.  If more professionals had questioned their own assumptions, listened more carefully to me, and done more research about potential therapies, it’s possible this stage could have begun much earlier, though that’s water under the bridge now.

Mental illness and developmental differences are often very isolating and alienating.  All patients deserve the relief of knowing that the first choice isn’t always the right one, and that there is no shame in speaking up for what you need.  Therapy is about the patient, not the therapist, and their well-being comes above preconceived value judgments and generalizations.

Why I stopped killing myself

There are many reasons I started drinking.  There’s only one reason why I stopped.

I remember the first time I got well and truly drunk.  I was 19, and I had bronchitis, as I tend to do several times per year.  I found that the only thing that soothed my cough and let me sleep at all was a bottle of wine that my mother in law (with whom I and my then-husband were living) had had in the fridge for some time.  I had sipped wine before, but never gotten more than a little buzz.  Without even realizing it, I ended up drinking the whole bottle of wine, and what I felt I had never felt before:  total relaxation, not caring anymore, feeling as if nothing mattered because a simple drink could make me forget it all.

Prior to that night, I had disdained alcohol.  I would go to parties at my parents’ friends’ houses and see people drinking and acting like fools, laughing too loud and talking too much, and I always thought “I never want to be like that,” so I would choose a glass of ice water over wine or beer.  In that moment, with that bottle of white zin, everything changed, even though I didn’t know it for a long time.  I started keeping a bottle of vodka in the fridge and making a Bloody Mary or The Vodka Still Works (= ginger ale + bitters + vodka) when I felt stressed out.  (To his specious credit, my then-husband would get upset with me and pour out my drinks, saying he “wouldn’t let me become an alcoholic,” although I think his motivations had much more to do with control than concern.)

But it wasn’t until a few years later that I really understood what alcohol could do for/to me.  I was divorced and had just gone back to university, and every time I was assigned a paper and tried to work on it, I froze up, panicked, couldn’t work, and the more I couldn’t work the more I hated myself and the more stressed I got.  So one night, convinced I was going to fail at anything I ever tried to do and never be loved or understood by anyone, I went to the store and bought a bottle of Merlot.  I drank the whole thing, and I lay on the floor puking into my wastebasket and I thought: “This is it.  This is the solution to every problem I’ve ever had.  If I could just feel like this all the time, everything would be okay.”  And being that I had drunk such small amounts before, I had virtually no hangover/withdrawal, so it seemed there was no downside.

Within the year after that, I began to have opportunities to socialize with people I’d met in class, which scared the fucking shit out of me.  It had been years since I’d had a “friend” or really spent time with anyone who wasn’t my abusive, possessive husband or partner.  Suddenly I understood that if I drank while I was with other people, I could stop feeling so petrified and actually talk to them. 

For the first time in my life, I went to parties, I chatted, I flirted.  I did the things I didn’t know how to do, and I didn’t realize until much later that I was actually being my usual bumbling, bizarre self only less toned down because I had no inhibitions while drunk.  I said whatever came into my head, which, it turns out, usually means I’m being a rude, insensitive asshole. 

I started making stupid irrational decisions, dating people with whom I had nothing in common and then suddenly declining their calls and dropping off the face of the earth.  I had unprotected casual sex even though I hated it, because it just didn’t seem to matter one way or the other.  I didn’t care about anything anymore.  I stopped planning my time and would rush off my assignments while shit-faced drunk at 3AM, knowing in my overconfident stupor that I’d get an A anyhow.  I burned a hole in my stomach that still flares up in times of stress.  I started to have constant tremors and sometimes hallucinations when I didn’t drink, and the obvious solution seemed to be to drink more, to drink all day every day, to just never be sober on the days when I wasn’t caring for my son.

Then I met Person of Interest, and for the first time somebody had a genuine, vested interest in asking me not to drink and abuse drugs.  I knew he loved me, though I didn’t understand it, and I knew why he wanted me to be sober.  But it wasn’t enough.  I would try very hard for weeks to not drink at all, because I was madly, head over heels in love with him and I wanted to do anything that would make him happy.  And then something stressful would happen and I would go on a total bender.  My mental health was beginning to decline drastically, and it was a terrible time for that to happen, while navigating a new relationship.

 Fast forward 9 months; I was hospitalized and then went into rehab.  I tried twelve-stepping.  I attended and I listened and I thought, and at first it seemed like magic, and then pretty quickly it seemed like pretense– just another religion I didn’t really believe in, with its bible and its catechisms and its rituals.  But there was a moment in rehab when everything changed, and it had nothing to do with AA or NA or abstinence or any of the rules or skills I was taught.  As often happens with me, my life changed because someone told me a story.

If you’ve read my Dysfunctional Fairytales, you will recognize this story as incorporated into the first, because it made such an impression on me.  During a meeting, a young woman stood up and recounted the story of how she watched her sister die of an overdose.  “She was a beautiful African-American woman,” she said with tears rolling down her cheeks, “and when I looked in her eyes, I could see that she would be dead, because they were grey, they were just grey.” 

And then she spoke of the children of her sister.  “I try to be close to them, but I can barely stand to be around them because the girl, she looks so much like her mom.  And the boy, he was two when she died, and I was taking care of them.  He’d wake up at night sweaty and screaming and crying ‘My mommy died.’  I miss her, she was my sister, but I hate her a little bit because of what she did to that little boy.”

I am a parent of a little boy, who was five when I heard the story.  And my heart broke.  I realized how selfish I had been, and that no matter how bad I felt, no matter how much agony, my son was worth any price.  As long as he was in this world, unless I abused him, which I would never do, it was better for him to know his mom– even if he ended up hating me– than to know that I killed myself, poisoned myself slowly, before he could even know me and decide.  I couldn’t– I can’t– bear the thought of him going through what that poor little two year old did, and I knew that I had a choice to spare him.  How could I choose any other way?

I’m not going to lie; I’ve gone on a few benders since that night.  I’m no angel.  I’ve relapsed, but it doesn’t last long, because with every drink I’ve taken since then that little boy’s face and voice, as I imagine them, have haunted me.  I may be many things but one thing I cannot do is harm a child, and to kill myself would be to irreparably harm the most beautiful child who has ever existed.  And to continue to drink day and night, to fool myself into treating it as a medication that I deserve, is no different from slitting my throat very slowly.  Any day, I could have gone into DTs and never recovered.  Any day, I could have been gone.  No matter how much it hurts, no more.  Never again.

Woman on woman

I am currently going through intensive outpatient rehab for drug and alcohol abuse.  And the facility I’m attending is an all-female one.

At first this fact barely registered with me, because, as George R. R. Martin famously said, “I have always thought of women as people.”  When I did start to think about it, at first it made me uncomfortable, even irritated.  As I’ve written about in previous posts, I am a strong advocate of not only sexual equality but sex blindness (on the condition that full equality is achieved) so I’m not thrilled about treatment being segregated.

In addition, I have always felt equally comfortable mingling with men and women.  Being queer, I experience no disparity caused by attraction; not being particularly feminine or masculine, I don’t find I have more or less in common with people on the basis of gender, sex, or orientation.

So it came as an unpleasant surprise to me when I soon realized that I actually am more comfortable in an all-female environment in this specific instance.  The obvious question it brings to mind is, why?  Why do I feel less self-conscious and more at ease than I would if men were present in our groups and classes?

It hasn’t taken me long, though, to come up with the answer, and it’s not about how I relate to men or women, but how they relate to each other.  Analyzing the dynamics of our interactions, I realized that the way the other patients interact with each other and with me is markedly different from how they would behave in a mixed environment.

A few examples:  Waiting for a support group to start on Monday, we ended up having a long and light-hearted conversation about the size and sagginess of our breasts.  Many of us, also, have experienced severe sexual trauma in heterosexual relationships, about which we speak very frankly.  And the terms “sisters” and “sisterly love” are ubiquitous– even I, not prone to finding heartwarming cliches appealing, have used it in a genuine way several times.

I don’t believe any of these communications would take place, or at least not in the same way, were men present.  For the most part, the patients identify as heterosexual and cisgendered.  Comparing our interactions to those of mixed groups– even those involving socially liberal and aware people– I realize that when both sexes are around, there is invariably an unspoken subtext of sexual tension and self-consciousness:  People may not be interested in one another; they may not be flirting; but they are constantly sizing each other up on the basis of attraction, and that’s reflected in their verbal and physical communications.

Women often don’t talk about their bodies or their sexual history and preferences, because there’s a sense that this might be either uncomfortable or arousing for their male company.  (Having, obviously, not been privy to all-male groupings, I don’t know if there are subjects that they similarly address only with other men, but I would expect so.) And there is no appropriate and simple equivalent to “sisterly love” in a mixed setting.  “Brotherly love” indicates affection between two men.  “Sibling-y love?”  That just sounds ridiculous.  “Familial love?”  Overly formal.  And even were it qualified, using the word “love” between heterosexual men and women conjures awkward connotations of romance.

That’s how ingrained, I believe, heterosexual attraction and coupling is in our society.  It so pervades our media and social norms that even when people don’t know what they’re doing, and would if asked disavow altering their behavior on sex-based grounds, they unconsciously find it impossible to break free of that early socialization.

So of course I’m more comfortable in this environment.  Talking openly about our most intimate experiences, forming bonds that can support us through the most difficult fight of our lives, making the most of our opportunity for sobriety– this requires lines of communication that aren’t blocked by coyness and reservation.  Cheesy or not, it requires unquestioned sibling-y love.

This makes me feel simultaneously depressed and relieved.  Depressed because it’s become clear to me how large a role sex and gender, like race, by default play in the interactions of even the supposedly enlightened.  And because I wonder whether I unwittingly change my behavior in the same way, which would demolish some of my claim to being unbiased and ungendered.  Yet, relieved, because it reinforces my belief that people need not be consciously discriminatory, even when they come across as such:  I don’t have to feel guilty for being comfortable in an all-female environment, because it reflects a social, not a personal, reality.

That’s what it boils down to, in the end.  However much I might wish that sex didn’t play a role in how people treat each other, that’s not (yet) a reality.  In almost every situation, I would argue that even when it feels awkward, mixed interaction needs to be encouraged, because that’s the only way it will become standard and truly comfortable– by people learning to deal with each other as individuals in real-world scenarios that necessitate common non-sexual purposes, in the same way that racial equality could only be facilitated by legally ending segregated schools and businesses.

However, in this specific case, we are talking about immediate rehabilitative care that for many may be life-saving if done right.  If that means using sexual segregation as a means, for now, because it helps this treatment be more effective, then as grudgingly as I admit it, that’s what needs to be done.